ERDoc

The VAC I used to ride for had to levels for those under 18, youths and students. From 13-15 we had a youth program. People in this program attended the student/youth trainigs and meetings and also the adult trainings. They were not allowed to ride the ambulance. For those under 18, we had a student program that was the same as the youth program, opnly you were allowed to ride the ambulance. Many of the students became Certified First Responders (in NYS) free of charge. They were also allowed to participate in all outside activities such as parades, christmas parties, installation dinners, etc. It was a great experience and provided many experienced adult memebers.

Did they change over to MetroCare around 1998, or was that just the NY office?

Which office did you TranScare guys work for?

You betcha!

No matter how hard you try, you will never be able to weed out the idiots. Let's take a look at doctors. We have idiots graduating from medical school all the time and have learned how to deal with them. You will need to develop a place where their exposure to pts can be minimized. In the hospital, we have developed such a place. We call it the OR. :wink:

I used to work for "the driving force in health care."

Let me answer the question about my system first, the answer would be...NO. I can see field chest tubes as useful in areas where there is a prolonged response time, but only by trained personel. I don't feel a knife belongs in every paramedics hands. You are talking about a surgical procedure done under less than perfect conditons. I agree with Rid, there needs to be QA/QI and very close monitoring. There are so many potential complications that makes it a dangerous procedure, even in the ER. I've seen seasoned surgeons put the tube in the abd cavity (nothing like seeing stool come out of a chest tube to tighten the sphincter). I do have to say though, that I have not had any experience with medics outside of my area. My feelings on this might be different if I were to see medics from other areas. There are medics in my area that I would have no problem with putting in chest tubes, but most I would not feel comfortable.

I'm curious, those of you who put in chest tubes, please describe your techniques.

I'm not impressed with the second absract (granted I'm only basing my opinion on the abstract and not the full article). The abstract does not say what the level of training was for these aeromedical crews (medics, nurses, MDs?). What country was this from (again, may account for different level of training)? I am also not impressed with doing a retrospective study from a trauma registry. How many people were excluded? What information was missing that caused them to be excluded? Would this information have changed the results of the study? A prospective study would need to be done to be of value.

Interesting study. Now someone needs to compare prehospital medic chest tubes and it may make it a benefit to the prehospital world (really, how many flight physicians are there really).

My county is 912 sq miles with a population of 1.5 million. We have about 100 volunteer FDs and VACs with thousands of members. Some ALS companies, some BLS companies. Probably close to 1 billion dollars in equipment. We also have several private companies that do NH transports and renal round-up. Even with all of this, we still have problems getting ambulances out to calls. It amazes me that those in the rural areas are able to provide such good service when some of us in the not so rural areas are having trouble. Keep up the good work everyone.

We can add B.S. also (no, not bulls***).

Hey!! What about MD????

The MAST is still in the NYS protocols, but after every reference it says, "if available and regionally approved."

I stand corrected. It did not register that they were talking about hip fxs. There's no purpose to use them in HIP fxs, but they are good for PELVIC fxs. The question is, how do you reliably tell the difference in the field?

Ace, I'd be pretty impressed to see a pt come in with MAST on to stabilize a pelvis fracture. What do you think we do when a pt comes in with an open-book pelvic fracture (no, it is not necessarily an open fx)? We take a sheet, wrap it around the pelvis and apply pressure to keep the pelvis stable so that none of the great vessels are injured from the bone fragments. Sounds like a poor man's version of MAST to me (assuming you don't inflate the leg compartments). I realize that you cannot xray the pelvis in the field so you cannot tell if there is an open-book fx or not, but I don't see the problem with it (obviously you have to follow your local protocols). Sure, we'll probably take them off as soon as we get the pt, but it still stabilized the pelvis during transport. I'd like to see the literature that says that MAST is contraindicated in a pelvic fx. I don't think that you would find anyone (at least EM trained) that would have a problem with stabilizing an unstable fx.

It didn't happen to me, but it is funny none-the-less. I was working in the trauma room and one of my medic friends gives her hospital presentation as she is coming in on the helicopter. She says she has a male ped struck with an open hard palate fx. Once she gets in, my first concern was to see what kind of airway issues we had to take care of. I look in and it was worse than I thought. I reach in and pull out this 30 something year old guys fractured denture!!! The hard palate was perfectly intact. Sure enough, I had to pick on the medic a little. I would expect it from someone that was new, but she was probably a medic for at least 5 yrs. It made for good laughs that day. On a side note, just to add a clinical pearl, if a pt is critical enough to have unequal pupils to the extent described above, they are not going to be conscious. Unequal pupils are an ominous sign that the brain is starting to herniate and the pt may be on their way to the ECU.

I used to feel the same way, until I started watching and realize what is actually involved. While I would not classify it as a "sport" it is just as physically intense, if not more, as most sports. Imagine driving your ambulance code 3 at almost 200mph for 500 miles. Imagine the amount of mental concentration it takes to avoid getting into one of those crashes (hey, eveyone loves to watch a good crash, anyone who tells you they don't is lying). Unlike those athletes in the traditional sports, the drivers don't get many breaks. They are running on adrenaline for hours on end. It's not like football or baseball (if you consider that a sport) where you have a few seconds of play followed by a longer lull in the action. There are no time outs, no half time show, no 7th inning stretch. Once it starts, with very few exceptions it goes till it's over. I'm not trying to convert anyone, but just respect the fact that there is more to it than just go fast, turn left and that is just as physically and more mentally demanding than traditional sports.

Being from Alaska I guess we can forgive you for not knowing what NASCAR is. North American Stock Car Auto Racing. It's the most popular stock car racing series in the world.

Hey, there are two races each year where they have to make right turns. They are also making those left turns at almost 200mph with only a few inches between them and every car around them.

Alright, I started a poll. I couldn't put on everyone who is not mathematically eliminated since I could only put on 10 choices. If there is anyonenot on the list, you could always give them a write in vote. Personally, Jr. will not make the chase. Gordon will make it in. JJ will start his usual come back soon and take the cup with Stewart coming in second and Gordon 3rd. However, I am a die hard Martin fan (hey, you can't hate the guy who drives the Viagara car) and would like to see him finally win the cup in what is supposed to be his last season.

Alright, I know this isn't the best place to put this, but I coulldn't find a better place. For all of those NASCAR fans out there, with 2 races left till the chase, who is going to win? Will Jr make it in? Will Gordon stay in?

Personally, I think losing those green pants was a step in the right direction (no offense). Those things we so 1970s. Just my opinion though.

I stand by what I said. I am not talking about wearing dress uniforms for special occasions. I am talking about when you are out in the field. You are not a cop or a firefighter, you just don't need it. You want to be treated as a medical professional or as an LEO? There is just no need for it. As I said before, put a patch on your sleeve so everyone can tell what level you are. Anything more and you are a buff. The badges imply some form of authority, which we do not have. As for the uniform allowance, I think we might have gotten a few bucks, but it was only like 15 or 20 dollars. Cheap-ass company (sorry, did I say that out loud?).

Show me the study!